Is mean platelet volume a simple marker of non-alcoholic fatty liver disease?

BACKGROUND: Due to the increasing prevalence of non-alcoholic fatty liver disease (NAFLD), there was a need to establish non-invasive tests for its detection. Mean platelet volume (MPV) is an inexpensive, practical and easily accessible marker of inflammation in many disorders. Our study was aimed at investigating the relationship between MPV and both NAFLD and liver histology. METHODS: Total 290 patients with biopsy-proven NAFLD (n = 124) and 108 control patients were included in the study. To exclude the effect of other diseases on MPV, we included 156 patient controls in our study. Those whohave liver-related diseases and those who use drugs that may cause fatty liver were not included in the study. Liver biopsy was performed for those whose alanine aminotransferase level persisted for >6 months above the upper limits. RESULTS/CONCLUSION: We found that MPV was significantly higher in the NAFLD group compared with the control group, and MPV had an independent predictive value for the development of NAFLD. We determined that the number of platelets was significantly lower in the NAFLD group compared with that in the control group. We compared MPV values histologically with both stage and grade in all patients with biopsy-proven NAFLD and found that MPV had a significant positive correlation with stage. We observed a positive correlation between MPV and non-alcoholic steatohepatitis grade, but this was not statistically significant. MPV can be useful because it is simple, easy to measure, cost-effective, and routinely tested in daily practice. MPV can be used as a simple marker of NAFLD and an indicator of fibrosis-stage in NAFLD.

Prognostic value and morphological findings of overexpression of glypican-3 in hepatocellular carcinoma.

OBJECTIVES: Hepatocellular carcinoma (HCC) is the seventh most common cancer all worldwide and is second in cancer-related deaths. In HCC, whose prognosis is still not good despite current treatments, there is a need for prognostic markers as well as early diagnosis. Glypican (GPC)-3 has been proposed as a potential serologic and histochemical marker specific to HCC. This study aimed to determine the relationship between GPC3 overexpression and HCC prognosis and clinicomorphologic features. MATERIALS AND METHODS: In total 152 patients who were diagnosed as a result of hepatectomy, lobectomy or liver transplantation were enrolled. The patients were divided into two groups, GPC3-positive (overexpression) (>10%) and GPC3-negative (<10%). The demographic data of the patients, tumor characteristics and survival times were recorded. RESULTS: Survival was significantly lower in the GPC3+ group. In the multivariate analysis, hepatitis C, AFP, tumor number, tumor focality, portal vein tumor thrombosis and GLP3 positivity were found to be independent risk factors for survival. CONCLUSION: Our study shows that GPC3 overexpression is a poor prognostic factor in HCC. GPC3 positivity were found to be an independent risk factor for survival.

Prognostic markers in cirrhotic patients requiring intensive care: a comparative prospective study.

INTRODUCTION: The use of prognostic models for cirrhotic patients admitted to the medical intensive care unit (ICU) is of great importance, since they provide an objective evaluation for a group of patients with high mortality rates and high resource utilization. OBJECTIVE: To evaluate the validity and to compare the prognostic predictive value of the CTP, MELD, SOFA and APACHE II scoring systems in cirrhotic patients admitted to the ICU, the CTP and MELD models being exclusive for patients with liver disease. MATERIAL AND METHODS: Commonly used predictors of mortality such as age, sex, CTP, MELD, APACHE II and SOFA were evaluated, and their prognostic value was investigated. RESULTS: A total of 201 patients were included in this study. Patients who survived had mean CTP score of 9.5 ± 2.4, MELD score 18.1 ± 7.1, APACHE II score of 13.4 ± 4.8 and SOFA score of 4.2 ± 2.6, compared to respective scores of 11.4 ± 2.8, 28.0 ± 11.2, 24.6 ± 10.4 and 8.7 ± 4.0 in patients who died. The difference between groups was statistically significant for each of one of the scoring systems (p < 0.001). CONCLUSION: In this study, SOFA was found to be the most powerful predictor of prognosis for cirrhotic patients admitted to the ICU. This was followed by APACHE II, MELD and CTP models, in descending order of strength (AUROC values of 0.847, 0.821, 0.790 and 0.724, respectively).

Seronegative Celiac Disease in Patients with Isolated Refractory Dyspepsia and Gastroesophageal Reflux Disease.

Background/Aims: To investigate the presence of seronegative celiac disease in patients with isolated refractory dyspepsia and gastroesophageal reflux disease (GERD)-related complaints. Methods: This was a single-center, prospective study performed at a tertiary care referral hospital. Among 968 consecutive patients, 129 seronegative patients with tissue damage consistent with Marsh IIIa classification or above were included. The patients were divided into two groups: dyspepsia (n=78) and GERD (n=51). Biopsies were taken from the duodenum regardless of endoscopic appearance, and patients with Marsh IIIa or above damage were advised to consume a gluten-free diet. The Glasgow Dyspepsia Severity (GDS) score, Reflux Symptom Index (RSI), and Biagi score were calculated at baseline and every 3 months. Control endoscopy was performed every 6 months during follow-up. Results: The median follow-up time was 19.9 months (range, 6 to 24 months) in the dyspepsia group and 19.2 months (range, 6 to 24 months) in the GERD group. All the patients were positive for the HLA-DQ2 and DQ8 haplotypes. The differences between the mean GDS scores (14.3±2.1 vs 1.1±0.2, respectively, p<0.05), RSI scores (6.3±0.8 vs 0.7±0.1, respectively, p<0.05), and Biagi scores (3.1±0.4 vs 0.7±0.3 in the dyspepsia group and 2.5±0.4 vs 0.5±0.2 in GERD group) before and after implementation of the gluten-free diet were statistically significant. The decreases in the scores were consistent with improvements in the histological findings. There was no significant correlation between endoscopic appearance and histological examination results (p=0.487). Conclusions: Seronegative celiac disease may be considered in this group of patients. Even if a patient is seronegative and has normal endoscopic findings, duodenal biopsy should be considered.

Prognostic factors of elderly patients with hepatocellular carcinoma: should we be more courageous in treatment?

OBJECTIVES: Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis, its incidence increases with age. The risk of developing HCC is highest in the seventh decade. In this study, we aimed to determine the clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC in the elderly and young populations. METHODS: All patients aged ≥18 years who were diagnosed histologically between 2016 and 2020 were included in the study. Patients were divided into two groups: <70 years and ≥70 years. The clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC were compared in the elderly and young populations. RESULTS: A total of 407 patients were evaluated. There were 164 patients (40.3%) in the geriatric age group. There was no significant difference in the female/male ratio, the laboratory values, survival time between the two groups. There was no significant difference between the two groups in terms of tumor focality and portal vein invasion ( P > 0.05). The presence of NAFLD, maximal tumor diameter (MTD), and portal invasion were found to be significant for survival according to the univariate analysis in elderly group ( P < 0.05). In the multivariate analysis, presence of NAFLD etiologically, and MTD independent risk factors were observed in elderly group ( P < 0.05). CONCLUSION: If the clinicomorphological features of the tumor and prognostic risk factors can be determined by examining the patients in detail, all treatments can be easily applied in the geriatric group.

What Is the Risk of Reactivation in Patients with Resolved and Past HBV Infection During Immunosuppressive Therapy If HBV-DNA Negative before Treatment?

BACKGROUND: Reactivation of Hepatitis B (HBVr) related to immunosuppressive drug therapy (ISDT) in patients with resolved and past infection is a challenging entity. The number of prospective long-term studies is limited. METHODS: Two groups of patients with resolved and past HBV infection were analyzed prospectively. The patients were further categorized as 266 patients receiving ISDT (group 1) and 246 patients receiving antineoplastic therapy (group 2). RESULTS: We did not detect any cases of HBVr among 108 patients receiving rituximab (71 of which were anti-HBc positive only), 111 patients receiving tumor necrosis factor inhibitors (66 of which were anti-HBc positive only), and 42 patients receiving high-dose glucocorticoids for more than 4 weeks (24 of which were anti-HBc positive only) during a mean follow-up time of more than 24 months. Subgroup analysis of the anti-HBs (+) patients showed that in group A (anti-HBs >1000 mIU/mL) the antibody levels did not change; in group B (anti-HBs between 100 and 1000 mIU/mL) the antibody levels changed non-significantly (P = .25), and in Group C (anti-HBs between 0 and 100 mIU/mL) the antibody levels declined significantly (P = .002). Furthermore, 16 patients in Group C had an anti-HBs loss during follow-up, but no HBVr was detected. CONCLUSION: The risk of HBVr by immunosuppressive therapy in this group may be lower than that suspected in the literature and anti- HBs levels may not seem to correlate with the risk of reactivation.

Helicobacter pylori eradication lowers serum homocysteine level in patients without gastric atrophy.

AIM: To determine whether Helicobacter pylori (H pylori)infection caused hyperhomocysteinemia by altering serum vitamin B(12), serum folate and erythrocyte folate levels and whether eradication of this organism decreased serum homocysteine level. METHODS: The study involved 73 dyspeptic H pylori-positive patients, none of them had gastric mucosal atrophy based on rapid urease test and histology. Out of 73 patients, 41 (56.2%) showed a successful eradication of H pylori 4 wk after the end of treatment. In these 41 patients, fasting serum vitamin B(12), folate and homocysteine levels, and erythrocyte folate levels before and 4 wk after H pylori eradication therapy were compared. RESULTS: The group with a successful eradication of H pylori had significantly higher serum vitamin B(12) and erythrocyte folate levels in the post-treatment period compared to those in pre-treatment period (210+/-97 pg/mL vs 237+/-94 pg/mL, P<0.001 and 442+/-212 ng/mL vs 539+/-304 ng/mL, P = 0.024, respectively), but showed no significant change in serum folate levels (5.6+/-2.6 ng/mL vs 6.0+/-2.4 ng/mL, P = 0.341). Also, the serum homocysteine levels in this group were significantly lower after therapy (13.1+/-5.2 micromol/L vs 11.9+/-6.2 micromol /L, P = 0.002). Regression analysis showed that serum homocysteine level was positively correlated with age (P = 0.01) and negatively with serum folate level before therapy (P = 0.003). CONCLUSION: Eradication of H pylori decreases serum homocysteine even in patients who do not exhibit gastric mucosal atrophy. It appears that the level of homocysteine in serum is related to a complex interaction among serum vitamin B(12), serum folate and erythrocyte folate levels.

Helicobacter pylori has no effect on plasma ghrelin levels.

OBJECTIVE: Helicobacter pylori is the major etiologic agent for chronic active gastritis, and it also plays a crucial role in gastric and duodenal ulcer disease, as well as in gastric carcinoma. H. pylori infection has been shown to decrease plasma somatostatin (SST) and increase plasma gastrin concentrations. Ghrelin is a recently discovered peptide produced mostly in the stomach of rodents and humans and is secreted into the bloodstream. There is no data in the literature about the relationship between H. pylori and ghrelin. DESIGN: Thirty-nine age- and BMI-matched H. pylori infection positive and negative women, from whom biopsy specimens were taken during gastric endoscopy, were included in the study. METHODS: Total ghrelin was measured by enzyme immunoassay (EIA) in Medistek. All samples were measured in duplicate and averaged; results differing by more than 20% were re-assayed. Two biopsy specimens from antrum, corpus and fundus were obtained. RESULTS: Fifteen of the subjects were H. pylori negative and 24 were H. pylori positive. Age, BMI, lipid profile and insulin sensitivity indices of the groups were similar. Plasma ghrelin levels (375.92+/-7.10 vs 370.00+/-4.14 pmol/l; P>0.05) of H. pylori negative and positive groups did not differ significantly. CONCLUSION: H. pylori has no effect on plasma ghrelin concentration.

Serum leptin level can be a negative marker of hepatocyte damage in nonalcoholic fatty liver.

BACKGROUND: The aim of this study was to determine whether leptin and insulin resistance (IR) showed differences between steatotic patients with and without elevated serum transaminases. METHODS: The study included 32 patients with fatty liver and high serum transaminase level (group I), 31 patients with fatty liver and normal serum transaminase level (group II), and 8 nonobese and nonsteatotic controls. The presence of steatosis was demonstrated by ultrasonography. Due to the effect of body mass index (BMI) on leptin levels, groups I and II were divided to form four subgroups for analysis (group IA, BMI 30; group IIA, BMI 30. RESULTS: The serum leptin levels in group IIB were significantly higher than the levels in group IB ( P = 0.017). Serum leptin was also higher in group IIA than in group IA, but this difference was not statistically significant ( P = 0.097). Logistic regression analysis revealed a significant negative correlation between serum leptin level and the presence of a high transaminase level (odds ratio, 0.97; 95% confidence interval, 0.95-0.99). The levels of IR in the four patient groups were comparable, but the controls had significantly lower IR levels than group IIA. CONCLUSIONS: Elevated serum leptin seems to be a feature of steatotic patients with normal transaminase levels, and the level of serum leptin seems to decrease as the hepatocyte injury develops. IR is a common feature of fatty liver disease, irrespective of the presence of hepatocellular necrosis.

Serum positive cagA in patients with non-ulcer dyspepsia and peptic ulcer disease from two centers in different regions of Turkey.

AIM: To investigate and compare frequencies of serum positive cagA in patients from two separate regions of Turkey who were grouped according to the presence of peptic ulcer disease or non-ulcer dyspepsia. METHODS: One hundred and eighty Helicobacter pylori-positive patients with peptic ulcer disease or non-ulcer dyspepsia were included in the study. One hundred and fourteen patients had non-ulcer dyspepsia and 66 had peptic ulcer disease (32 with gastric ulcers and/or erosions and 34 with duodenal ulcers). Each patient was tested for serum antibody to H. pylori cagA protein by enzyme immunoassay. RESULTS: The total frequency of serum positive cagA in the study group was 97.2 %. The rates in the patients with peptic ulcers and in those with non-ulcer dyspepsia were 100 % and 95.6 %, respectively. These results were similar to those reported in Asian studies, but higher than those that have been noted in other studies from Turkey and Western countries. CONCLUSION: The high rates of serum positive cagA in these patients with peptic ulcer disease and non-ulcer dyspepsia were similar to results reported in Asia. The fact that there was high seroum prevalence regardless of ulcer status suggests that factors other than cagA might be responsible for ulceration or other types of severe pathology in H. pylori-positive individuals.

Subepithelial basement membrane thickness in patients with normal colonic mucosal appearance in colonoscopy: results from southern Turkey.

AIM: Our aims were to determine the normal limits of subepithelial basement membrane (SEBM) thickness in order to more accurately diagnose collagenous colitis in the population from southern Turkey and to investigate into links between SEBM thickness and age, and sex. METHODS: The study included 100 patients (mean age 50.0+/-13.3 years; male, 34; female, 66) with miscellaneous gastrointestinal symptoms, and normal colonic mucosal appearance in colonoscopic evaluation. Biopsies were taken from five different regions of the colon. SEBM was measured with a calibrated eyepiece on specimens prepared with specific stains for collagen. Intensity of inflammatory cells was graded semiquantitatively. Differences in SEBM thickness among the different colon regions, and relationships between SEBM thickness and age, sex, and density of inflammatory cells were statistically evaluated. RESULTS: The cecum and rectum showed the largest amounts of infiltrate. None of the specimens showed histologic findings of collagenous colitis. The SEBM thicknesses measured for each case ranged from 3-20 microm. The biggest thickness was observed in rectal mucosa (median value: 10 microm). Cecum and ascending colon showed similar SEBM thickness (median value: 5 microm). SEBM thickness was not correlated with patient age or sex, but was positively correlated with the intensity of inflammatory cells in each colon segment. CONCLUSION: In this patient group from southern Turkey, SEBM was thickest in the rectum. Our results indicate that, in this population, SEBM thickness is not correlated with age or sex, but is positively correlated with severity of inflammation. The findings also support the concept that measuring SEBM thickness at one segment in the colon is inadequate and may be misleading.

Low eradication rate of Helicobacter pylori with triple 7-14 days and quadriple therapy in Turkey.

AIM: The eradication rate of Helicobacter pylori (H pylori) shows variation among countries and regimens of treatment. We aimed to study the eradication rates of different regimens in our region and some factors affecting the rate of eradication. METHODS: One hundred and sixty-four H pylori positive patients (68 males, 96 females; mean age: 48+/-12 years) with duodenal or gastric ulcer without a smoking history were included in the study. The patients were divided into three groups according to the treatment regimens. Omeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1 g were given twice daily for 1 week (Group I) and 2 weeks (Group II). Patients in Group III received bismuth subsitrate 300 mg, tetracyline 500 mg and metronidazole 500 mg four times daily in addition to Omeprazole 20 mg twice daily. Two biopsies each before and after treatment were obtained from antrum and corpus, and histopathologically evaluated. Eradication was assumed to be successful if no H pylorus was detected from four biopsy specimens taken after treatment. The effects of factors like age, sex, H pylori density on antrum and corpus before treatment, the total H pylori density, and the inflammation scores on the rate of H pylori eradication were evaluated. RESULTS: The overall eradication rate was 42%. The rates in groups II and III were statistically higher than that in group I (P<0.05). The rates of eradication were 24.5%, 40.7% and 61.5% in groups I, II and III, respectively. The eradication rate was negatively related to either corpus H pylori density or total H pylori density (P<0.05). The median age was older in the group in which the eradication failed in comparison to that with successful eradication (55 yr vs 39 yr, P<0.001). No correlation between sex and H pylori eradication was found. CONCLUSION: Our rates of eradication were significantly lower when compared to those reported in literature. We believe that advanced age and high H pylori density are negative predictive factors for the rate of H pylori eradication.

Obesity and related parameters of non-alcoholic steatohepatitis.

BACKGROUND/AIMS: The aim of this prospective study was to evaluate the clinical, biochemical and histopathological parameters of nonalcoholic steatohepatitis and the conditions associated with this disease. METHODS: Twenty-four patients were included in the study, each having been diagnosed with nonalcoholic steatohepatitis on the basis of liver biopsy and elimination of other possible causes of elevated aminotransferase levels. Measurements of degree of obesity, liver enzymes and serum lipids were recorded before liver biopsy and reevaluated after one or two months of a standard exercise and diet program. Serum insulin levels were also measured. Each liver biopsy was histologically examined for steatosis, inflammation, fibrosis, necrosis and iron storage, and semiquantitave assessment of these was recorded for three separate hepatic zones. RESULTS: The prevalence of obesity in the group was 79.2%, while the figure for overt and latent diabetes mellitus combined was 33.3%, and for hyperlipidemia was 83.3%. Compared to the rest of the group, the patients with severe steatosis had significantly higher serum lipid (particularly high triglyceride) and insulin levels (p<0.05 for both). There was a correlation between steatosis and obesity (p=0.06). More severe obesity, higher insulin and elevated aspartate aminotransferase were positively correlated with inflammation, whereas elevated serum triglyceride was negatively correlated with inflammation. There was a tendency towards normalization of liver enzyme levels after weight loss and dietary restrictions. CONCLUSIONS: Obesity and hyperlipidemia were associated with nonalcoholic steatohepatitis in the group studied. Obesity is not a factor in every case, but the study showed that restricted diet and exercise are significant forms of therapy for nonalcoholic steatohepatitis.

Relationship between gastritis severity, Helicobacter pylori intensity and mast cell density in the antrum and corpus.

BACKGROUND/AIMS: The aim of this study was to investigate the relationship between mast cell density, Helicobacter pylori intensity and histopathological severity of gastritis in the corpus and antrum mucosa. METHODS: The study included 59 Helicobacter pylori-positive and 20 Helicobacter pylori-negative patients. All cases underwent endoscopy, and biopsies were obtained for the evaluation of Helicobacter pylori and histopathological examination. All biopsies were evaluated according to the Sydney system and mast cell density in both the corpus and antrum mucosa was analyzed by modified Giemsa stain. Spearman's correlation test was used to determine the relationship between mast cell density and other histopathological parameters. The comparision of mast cell density between H. pylori positive and negative groups was analysed by Mann Whitney U test. RESULTS: Both in the antrum and the corpus, mast cell density was significantly higher in the Helicobacter pylori-positive group than in the Helicobacter pylori-negative group (p<0.001). The higher mast cell distribution was correlated with increased inflammation, activity and Helicobacter pylori in the antrum and corpus (p<0.001). No relationship was found between mast cell distribution and intestinal metaplasia or atrophy. CONCLUSIONS: In the light of the results of our study, mast cells may play a role in the development of Helicobacter pylori gastritis.

Endoscopic extraction of living fasciola hepatica: case report and literature review.

Fasciola hepatica infestation is known to cause bile duct inflammation and biliary obstruction. Endoscopic retrograde cholangiopancreatography shows distinct features in some patients with fascioliasis, but the condition may be overlooked in chronic cases. The endoscopic retrograde cholangiopancreatograpy images must be carefully examined to rule out other possible causes of irregularity and thickening of the common bile duct wall. Parasite removal during endoscopic retrograde cholangiopancreatograpy is one therapeutic option in patients with acute obstructive cholangitis due to F. hepatica. We present a case of fascioliasis-induced acute cholangitis that was diagnosed and treated via endoscopy. A review of the literature on extraction of living parasites is also included.

Clinicopathologic features and risk factors for hepatocellular carcinoma: results from a single center in southern Turkey.

BACKGROUND/AIMS: The aim of this study was to determine the characteristics of hepatocellular carcinoma at a major health center in southern Turkey. Computed tomography was compared to the combination of ultrasonography and serum alpha-fetoprotein determination in the diagnosis of hepatocellular carcinoma. METHODS: Of 226 patients with liver cirrhosis, 35 were diagnosed with hepatocellular carcinoma on first admission or during follow-up in the period between 1999 and 2002. The features investigated were, age at time of hepatocellular carcinoma diagnosis, etiology of cirrhosis, severity of cirrhosis at presentation, tumor pattern, stage of hepatocellular carcinoma, serum alpha-fetoprotein level, and dynamic computed tomography findings. Results were compared to previous findings in Turkey and elsewhere. RESULTS: In the hepatocellular carcinoma patients, the male:female ratio was 4:1 and the mean age at presentation was 61 years. Chronic hepatitis B virus infection (65.7%) and chronic hepatitis C virus infection (28.6%) were the most frequently identified risk factors for hepatocellular carcinoma. Forty percent of the patients had Child-Pugh A cirrhosis when they were diagnosed with hepatocellular carcinoma. Sixty-seven percent of patients had fewer than three hepatocellular carcinoma nodules in the liver at the time of diagnosis. Only three of the hepatocellular carcinoma cases were Okuda stage I. The combination of ultrasonography and serum alpha-fetoprotein >20 ng/ml identified hepatocellular carcinoma in 32 of the 35 total cases. CONCLUSIONS: The results indicate that hepatitis B virus infection in patients with cirrhosis is still the leading risk factor for the development of hepatocellular carcinoma. Also, early-stage hepatocellular carcinoma is rarely diagnosed in cirrhosis patients from this region of Turkey. Surveillance with computed tomography for early diagnosis of hepatocellular carcinoma seems not to be mandatory.

Predictors of vitamin B12 deficiency: age and Helicobacter pylori load of antral mucosa.

BACKGROUND/AIMS: The aim of this study was to assess the frequency of vitamin B12 deficiency in patients with non atrophic gastric mucosa and any relationship between the presence of vitamin B12 deficiency and demographic, hematologic, and histopathologic parameters. METHODS: Three hundred and ten patients with no gastric mucosal atrophy on histologic evaluation were included in the study. Chronic inflammation, neutrophil activity and H. pylori load were scored using the Sydney classification system. Variables that might influence or predict the presence of vitamin B12 deficiency (age, gender, hemoglobin, mean corpuscular volume, serum folate level, scores of histologic parameters) were evaluated by univariate/multivariate analysis. RESULTS: The percentages of patients with vitamin B12 concentrations of < 250 pg/mL, < 200 pg/mL, and =100 pg/mL were 67.4%, 46.8% and 6.5% respectively. Patient age and all three histologic were inversely related to vitamin B12 deficiency (p<0.05). By multivariate analysis, factors independently associated with serum vitamin B12 deficiency were age and antral H. pylori load (p<0.05). CONCLUSIONS: The higher frequency of vitamin B12 deficiency in this study compared with a western study may be a reflection of the effect of H. pylori infection on serum vitamin B12 level. In addition, age was shown to be an independent risk factor for vitamin B12 deficiency irrespective of gastric atrophy. It is already known that the presence of H. pylori on gastric mucosa influence serum vitamin B12 levels. Hematologic parameters are not useful in predicting the deficiency of this vitamin.

Five percent weight lost in the first month of intragastric balloon treatment may be a predictor for long-term weight maintenance.

BACKGROUND: Most of the weight loss with the BioEnterics intragastric balloon (BIB) has occurred during the first 3-4 months. This study aimed to evaluate the effect of initial weight loss on long-term weight maintenance. METHODS: From 2008 to 2011, 50 patients who had mean body mass index (BMI) of 44.7 ± 12.4 kg/m(2) underwent BIB therapy for 6 months. All patients were given a diet of 1,100 kcal/day. Weight loss parameters [absolute weight loss, BMI loss, percentage of body weight loss (BWL%), and percentage of excess BMI loss] were recorded at the baseline, 1 month, 6 months (time of BIB removal), 12 months, and 18 months from the baseline. Successful weight loss was defined as ≥ 10 % weight loss after 6, 12, and 18 months. RESULTS: Twenty-seven patients (54 %) achieved a percentage of BWL ≥ 10 at the time of removal. Eighteen (36 %) and 12 (24 %) patients were able to maintain weight loss of 10 % at 12 and 18 months. Percentage of BWL after 1 month was positively correlated with BWL% after 6, 12, and 18 months (r = 0.77, 0.65, and 0.62, p < 0.001, respectively). Twenty-four patients who lost 5 % of the BWL after 1 month of treatment succeeded in maintaining a lasting percentage of BWL ≥ 10 after the BIB removal: more precisely, this cutoff point was achieved in 96 % at the time of removal and in 71 %, 50 % at 12 months, and 18 months of follow-up. CONCLUSIONS: Five percent BWL after 1 month of treatment may be a predictor for long-term weight maintenance.

Long-term effectiveness of BioEnterics intragastric balloon in obese patients.

BACKGROUND/AIMS: The BioEnterics intragastric balloon has been considered an effective and less invasive method for weight loss. This study aimed to evaluate the effect of this method on long-term weight loss. MATERIAL AND METHODS: From June 2009 to June 2011, 32 patients (14 male, 18 female) underwent BioEnterics intragastric balloon therapy for 6 months. The mean age of the subjects was 39,7±11,1 years and mean body mass index was 44,4±12 kg/m 2 . All patients were given a diet of 1100 kcal/day. Weight loss parameters [absolute weight loss, body mass index loss, percentage of body weight loss, and percentage of excess body massindex loss (excess body mass index loss%)] were recorded at baseline, after 1 month, after 6 months (time of BioEnterics intragastricballoon removal), and after 12 months from baseline. Successful weight loss was defined as ≥10% weight loss after 6 (end of treatment success) and 12 months (long-term success). Statistical analysis was done using SPSS computer program. RESULTS: The mean weight loss and body mass index loss were 12,4 kg (standart deviation, 13,5) and 4.3 kg/m 2 (standart deviation, 4,7), respectively (p<0.001). The mean percentage of body weight loss was 9.5% (standart deviation, 9,8). The percentage of excess body mass index loss reached 25,2% (standart deviation, 25,9). Fifteen patients (46,9%) achieved a percentage of body weight loss >10% at the end of treatment. Eleven of these patients (73%) were able to maintain weight loss of 10% at the completion of the study, resulting ina longterm success rate of 34.4%. Percentage of body weight loss and percentage of excess body mass index loss were inversely relatedto age (p< 0,05). CONCLUSION: BioEnterics intragastric balloon has been effective in long-term loss of body weight.

Comparison of the efficacy of tenofovir and entecavir for the treatment of nucleos(t)ide-naive patients with chronic hepatitis B.

BACKGROUND/AIMS: Chronic hepatitis B virus infection is an important cause of morbidity and mortality. Tenofovir disoproxil fumarate and entecavir were licensed for the treatment of hepatitis B virus infection. We evaluated the first 12 months of chronic hepatitis B treatments with tenofovir and entecavir and compared their efficiencies. METHODS: The study enrolled 94 chronic hepatitis B patients with compensated liver disease. The entecavir group consisted of 29 patients who received entecavir 0.5 mg/day and the tenofovir group consisted of 65 patients who received tenofovir 245 mg/day. There was no statistically significant demographic or HBeAg status difference between the groups. Patients returned to the clinic every four weeks for laboratory assessments of serum chemical and hematologic values, liver function and for documentation of any adverse events. Hepatitis B serologic markers and HBV-DNA levels were assessed every 12 weeks. The primary efficacy endpoint was a plasma HBV-DNA level of less than 400 copies/ml over 48 weeks. RESULTS: At the end of 48 weeks, treatment with either tenofovir or entecavir resulted in clinically important suppression of HBV-DNA, as 71.3%. There was no statistical difference in inducing undetectable levels of HBV-DNA between the entecavir (69%) and tenofovir (72.3%) groups. Furthermore, no side effect as an increase in creatinine was seen. HBeAg seroconversion was seen in only one patient in the entecavir group, but in no patients of the tenofovir group. CONCLUSIONS: In the first year of treatment for chronic hepatitis B, virologic response and tolerability did not differ significantly between tenofovir and entecavir. Both drugs are safe and efficacious for patients infected with HBV.